Statins are the drugs of first choice for lipid lowering. 

  • All currently available statins have long-term evidence of safety. 
  • For acute coronary syndromes atorvastatin 80mg daily is the drug of choice.
  • If side-effects occur consider a lower dose or alternative statin. Review the dose annually.
  • Interactions: Statins can interact with many drugs, eg diltiazem, verapamil, amiodarone, warfarin, macrolides, antivirals, antifungals. It is important to check for interactions before prescribing and advise patients to avoid drinking grapefruit juice. See: BNF.
  • Muscle effects: Rhabdomyolysis associated with lipid-regulating drugs such as the fibrates and statins appears to be rare (approximately 1 case in every 100 000 treatment years) but may be increased in those with renal impairment and possibly in those with hypothyroidism. Concomitant treatment with drugs that increase plasma-statin concentration increases the risk of muscle toxicity; concomitant treatment with a fibrate and a statin may also be associated with an increased risk of serious muscle toxicity. Refer to BNF.
  • Swallowing difficulties and NG administration: Rosuvastatin capsules are licensed to be opened and the contents administered. In NHS Highland rosuvastatin capsules, are non-formulary except for those patients who have swallowing difficulties, where other statin therapy has not been tolerated, or who require NG tube administration. 

Guidance

MHRA advice: Statins: very infrequent reports of myasthenia gravis (September 2023) (www.gov.uk).
MHRA advice: Statins: benefits and risks (December 2014) (www.gov.uk)
MHRA advice: Systemic fusidic acid and interaction with statins (December 2014) (www.gov.uk)
MHRA advice: Statins: risk of hyperglycaemia and diabetes (December 2014) (www.gov.uk)
MHRA advice: Statins: updated adverse reaction information in patient leaflets (December 2014) (www.gov.uk)

ATORVASTATIN - (First line)

Therapy notes

  • MHRA advice: Statins: very infrequent reports of myasthenia gravis (September 2023) (www.gov.uk).
    MHRA advice: Statins: interactions, and updated advice for atorvastatin (December 2014) (www.gov.uk).

Formulation and dosage details

Formulation:

Tablets 10mg, 20mg, 40mg, 80mg

ROSUVASTATIN - (Second line)

Therapy notes

MHRA advice: Statins: very infrequent reports of myasthenia gravis (September 2023) (www.gov.uk).

  • Rosuvastatin capsules are licensed to be opened and the contents administered. In NHS Highland rosuvastatin capsules, are non-formulary except for those patients who have swallowing difficulties, where other statin therapy has not been tolerated, or who require NG tube administration. 

Formulation and dosage details

Formulation:

Tablets 5mg, 10mg, 20mg

Tablets 40mg (specialist initiation only)

Formulation and dosage details

Formulation:

Capsules 5mg, 10mg, 20mg (non-formulary)

Dosage:

In NHS Highland rosuvastatin capsules, are non-formulary except for those patients who have swallowing difficulties, where other statin therapy has not been tolerated, or who require NG tube administration. 

Rosuvastatin capsules are licensed to be opened and the contents administered:

  • In swallowing difficulties the capsule can be opened and the contents sprinkled on soft food, for details see EMC.
  • The capsules are also licensed for NG administration, for details see EMC.

SIMVASTATIN

Therapy notes


  • Not recommended to be started as not high intensity statin.  Patients already on Simvastatin should be considered for change as per guidance for the use of Lipid lowering therapy in the prevention/treatment of atherosclerosis if appropriate.
  • MHRA advice: Statins: very infrequent reports of myasthenia gravis (September 2023) (www.gov.uk).
  • MHRA advice: Simvastatin: increased risk of myopathy at high dose (80mg) (December 2014) (www.gov.uk)
  • MHRA advice: Simvastatin: updated advice on drug interactions (December 2014) (www.gov.uk)
  • MHRA advice: Simvastatin: dose limitations with concomitant amlodipine or diltiazem (December 2014) (www.gov.uk)

Formulation and dosage details

Formulation:

Tablets 10mgOTC 

Tablets 20mg, 40mg

Tablets 80mg (specialist initiation only)

Editorial Information

Document Id: F053